Mother and baby in critical condition following "assisted delivery" at IGMH

Following a special "assisted delivery" at IGMH labour room in the early hours of sunday (3rd Feb 08) morning a mother and her baby are in a critical condition at IGMH. The mother, reported to us as a 35 year old first time mother who was past the due date for delivery, was admitted to IGMH for induction of labour.

We are able to confirm that both mother and baby are in intensive care following the use of a technique of delivery that is banned in modern obstetric practice. Apparently the maneuver is commonly employed at IGMH labour room by senior obstetricians, to bring about delivery of the babies where mothers have poor effort in pushing the baby out by herself. What is surprising is that a good number of nurses are also taught to use the technique at the labour room by the senior obstetricians. The maneuver includes applying excessive force on the upper part of the abdominal wall, over the fundus of the uterus, thus virtually squeezing the uterus between the mothers spine and the hands (and sometimes the arm and elbow) of the person applying the maneuver. This is apparently called "fundal pressure" a maneuver that is known to cause uterine injury, fetal cervical injuries, fetal cerebral hemorrhages, and significant other birth injuries such as Erb's palsy, fractured clavicle and major trauma to internal organs of both mother and baby.

In this case, a vacum machine was used to pull the baby out of the birth canal by attaching a suction cup to the baby's head and pulling on a cord attached to the cup. This is also a potentially harmful procedure, but one that is an accepted obstetric maneuver to effect delivery when the labour is prolonged and baby's condition deteriorating. In addition to the vacum application, nursing staff and obstetric doctors alternated in exhausting their stamina and strength in giving fundal pressure. The mother was subjected to this physical torture when the case could, and probably should, have been taken for a cesarean section delivery.

As would be expected from this extremely dangerous and traumatic process, the baby was born in a terrible condition. Even the senior pediatric doctor who was at the site could not revive the baby to a normal state. After a long attempt the almost dead baby was transfered to the new Newborn ICU for life support. The baby was in a critical condition when we got our last update; having found to have severe cerebral edema, intracranial bleed, seizures, pneumothorax and just barely hanging onto life. We were told that the baby could pass away any minute and that there wasn't much the doctors could do to avert such an end.

To add insult to injury, the family had to endure a grave turn of events for the mother as well. Apparently due to the excessive force used by the obstetrician and nursing staff in applying fundal pressure, the mother sustained injuries to her uterus and internal blood vesels. She had bleeding into her abdominal cavity and had to be taken up for emergency surgery to patch-up the injuries sustained in the traumatic birthing process. She remains in a critical condition in the adult ICU at IGMH, also fighting for her life.

The family is outraged at the horrific treatment they have recieved at the hospital with some members of the family unable to comprehend the gravity of the situation.

MMW understand that this "fundal pressure" maneuver has been a routine practice at IGMH since the department was taken over by the current head of department Dr Rabo Chako. We have also been told that a huge argument had broken up between the pediatric doctors and the obstetric doctors over the way this case was handled. We recieved reports that some angry pediatric doctors have demanded to have the case revieved, the "fundal pressure"  maneuver banned and some accountability established for these cases.

MMW learnt today that some of the nurses who were at the delivery were so traumatised themselves at the sight of a grown person virtually jumping up and down on the mothers pregnant abdomen that they left the delivery room in  protest.

These kinds of inhumane, unethical and potentially traumatic practices must be stopped and internationally acceptable practices established at IGMH. We call on the Maldives Medical Council, IGMH, MoH and other concerned authorities to investigate this case and bring those responsible to account. Dr Solih must take steps to get his house in order or leave the job to someone who can manage to acieve that.

1st Dengue Death for 2008 ?

A 7 year old girl, native to HDh. Hanimaadhoo, living in Male' has passed away within a few hours of arriving at IGMH Emergency Room (ER) from what is believed to be Dengue Hemorrhagic Fever with Shock.

A family member, who wish to remain anonymous, was contacted by our team on 27th January for details of what had happened. Our informer was clearly unhappy with what had transpired at IGMH and at home in the lead up to the child's death.

According to our informer 7 year old Ifaasha was first taken to IGMH ER on 25th of January because of fever for two days and severe vomiting with a very severe abdominal pain. Unfortunately, Ifaasha was taken to the hospital by a relative who did not know the details of her illness. Our informer suspects that this probably was one reason for the sad end to the story. In the ER, Ifaasha was seen by a junior doctor and given an injection for vomiting and sent home on Panadol doses for fever. Our informer reports that not much attention was given to Ifaasha's history and that she was rushed out of the ER and sent home without a full examination or investigations.

We were able to talk to 2 doctors, who also spoke to us on the condition of anonymity, from IGMH ER who gave a different version of events. According to the doctors, Ifaasha was brought to the ER by a distant relative who gave a history of fever for less than one day and abdominal pain. At examination, they report that, Ifaasha had no abdominal pain and the fever was mild. The rest of the examination was normal according to the doctors. This was the reason, they claim, that Ifaasha was sent home without any investigations. MMW notes why history was not taken from Ifaasha herself. She was big and mature enough to give a full history herself. The doctors reported to us that Ifaasha went home well on the 25th january and that the family was advised to bring the child back if there were any other problems.

Our informer reports to us that since returning home, Ifaasha continued to complain of severe abdominal pain. He also reported that after a few hours of returning home the vomiting had become worse and Ifaasha was unusually weak and sleepy. The parents however, did not worry much as they were assured by the ER doctors that what Ifaasha was having was Gastritis (gas- vaige undhagoo).

On the 26th January, less than 24 hours of the first visit to ER, Ifaasha fainted at home and looked really sick. Her mother, now concerned for Ifaasha's life rushed her to IGMH ER. When they arrived in ER for the second time, our informer reports that, Ifaasha was conscious but clearly very weak. She was made to lie in a bed and a junior doctor examined her while a nurse checked her blood pressure. Our informer reports to us that, his impression was that Ifaasha was too pale; "death pale" he had said.The ER doctors and the nurses then quickly swarmed around her and got an IV going. One of the doctors talked to the mother and said that they were unable to get Ifaasha's blood pressure and that they felt that Ifaasha was bleeding somewhere within her abdomen.

The ER doctors reported to us that Ifaasha was received in ER on 26th in shock with no recordable BP and was extremely pale. They suspected internal hemorrhage and tried to get urgent blood for transfusion.

In about 20 minutes of arrival in ER, Ifaasha was reportedly seen by a Pediatrician [Dr Sunil] and advised to be transferred to ICU for management of suspected Dengue Hemorrhagic Fever with Shock and hemorrhage.

Our informer reports that when transferred to ICU, Ifaasha was almost dying. He had himself lost all hope.

Within a couple of hours of Ifaasha being transferred to ICU she died from bleeding into her lungs and intestines. She had blood coming out of her mouth, when our informer last saw Ifaasha alive.

The ER doctors reported that Ifaasha may have been saved if they had blood available for immediate transfusion, blood bank was out of stock of O- blood. They also said that the history given to them on the second visit; fever for more than 4 days, had not matched with the first history given on 25th. This was the reason why investigations were not done on first visit, and diagnosis missed.

We were told by family members that that they accept the efforts of the doctors on the 26th of January, as they did everything they could to save Ifaasha. They were however, very bitter about the way Ifaasha was managed on the 1st visit. They felt that, a proper examination and investigations could have save Ifaasha.

One nurse from ICU reported to us that even at the time of death, no reports were available to confirm what Ifaasha had died from. The lab had taken too long to give the results. She told us that the reports, although not 100% diagnostic, were highly suggestive of Dengue Hemorrhagic Fever with internal bleeding.

Could this death have been avoided? Has the hospital started an internal evaluation into how the case was handled? Has the family been given a good enough explanation of what had occurred? When would IGMH administration consider setting up a mechanism to evaluate mortalities and major morbidities promptly, even if a complaint is not lodged? [Dr Solih repeatedly disconnected our call and as usual Dr Yasir is unavailable for comment].

Was this really the 1st Dengue death for the year?

Update:

1. Our informer reports that the family are considering sending a letter to IGMH and MoH to complain against the way the case was handled.

2. Over heard by an IGMH staff: The case is being discussed by the Department of Pediatrics and ER to see if case could have been handled differently. Initiative taken by Dr Zumra, not by hospital administration. The process is not likely to yield a report.

3. The lab reports were not delayed in the lab? Our sources at the hospital confirm that the samples were sent to the lab late, reports were generated as urgent, delay in collecting reports by ICU to blame for delayed availability of reports to treating doctor. MMW: with the new database system at IGMH, is it still not possible to view lab reports from ICU and other intensive care areas? When will this happen? Would having the reports available change the treatment?

4. Reports: we showed the report values to our team: thrombocytopenia, severe anemia, elevated liver leaked enzymes are all suggestive of DHF; and based on the clinical course: DHF with Shock and Hemorrhage are plausible diagnoses.

5. Case reported to DPH, officially, as a case of Dengue. DPH sources confirm that if proven (an internal review at IGMH is expected) this would indeed be the first Dengue death for the year. Our DPH source also reports that there is a small but significant increase in the number of cases of Dengue being reported in the past 1 month.

Life saving surgery?

This report is based on an unpublished article written by a Maldivian doctor stationed overseas reporting on an incidence that happened at IGMH. We received the article from Minivan News reporter who wishes to remain anonymous. The article was refused publication by the Minivan News Editorial team for unknown reasons despite the Minivan News reporter confirming authenticity of the events.

In October 2007 a baby born at IGMH was diagnosed to have Congenital Diaphragmatic Hernia, a condition in which the muscular sheath (diaphragm) separating the abdominal cavity from the thoracic cavity has a defect in it that allows intestinal loops and other abdominal content to herniate into the thoracic cavity. The condition is potentially life-threatening as the intestinal loops in the thoracic cavity would occupy the space that would otherwise have been occupied by the lungs. Depending on the severity of the herniation, the lungs could be compressed preventing respiratory functions.

The baby was admitted to the Neonatal ICU where investigations confirmed the diagnosis. The child remained stable even with the potentially life threatening internal deformity.

Cases of Congenital Diaphragmatic Hernia have been diagnosed at IGMH in the past as well. Reportedly, in the past 3 years, none of the previous cases had died. The procedure that was followed over the 3 years referred was to stabilize the patient and have them transfered to Trivandrum or Colombo accompanied by Pediatric doctors. Reportedly, in 2007 a total of 4 babies were transfered for varying surgical and severe medical conditions (including one with Congenital Diaphragmatic Hernia) under medical care of a Pediatrician. They all survived.

IGMH does not have a Pediatric surgeon. Neither does it have a general surgeon with enough expertise and experience is surgeries of the newborn. This is not to say that a general surgeon would be unable to undertake any life-saving surgeries at IGMH for newborn surgical conditions.

The baby in this case was in a stable medical condition, Pediatric orders for referral abroad were made and discussed with parents when the case was seen by Dr Mohamed Firdous and his puppet team of surgeons. He clearly wanted to "have a go" to see if he could add "did a correction of CDH" to his resume'. To make this possible, the parents were misinformed by the surgeon and a new Pediatric Head of Department Dr A.C. Bhagwat that the child was in a critical state and that unless surgery was done urgently child would die!

Left with no choice, the parents consented to surgery. The relatives were made to sign a "high-risk" surgery consent form. Clearly; a common practice by all surgical specialties at IGMH, attempting to reduce liability.

Details of surgery are sketchy. Surgery was done by Dr Firdous himself. Documents were never given to parents; they were given just a Death Certificate. MMW was able to confirm from IGMH theater staff that the child arrested during the surgery and could not be revived. However, on the orders of Dr Firdous, death was not declared. The lifeless body of the baby was transfered back to Newborn ICU and connected to a mechanical ventilator.

To our shock, we were told that the lifeless baby (no cardiac activity, breaths given by machine) was kept on "life support" for several hours before declared dead. The parents were lied to and the truth of the events hidden. The surgeons shamelessly declared the surgery a success; claiming to have repaired the diaphragm!

The way patients condition was mis-informed and parents misled before the surgery, during surgery and following surgery (surgical death) the parents had no way of understanding the grave injustice that was done to them. They weren't even aware of the devious scheme. Dr Firdous's misadventure, on this occasion and certainly on several previous occasions, were covered up by IGMH.

The case, as was done for previous cases, should have been transfered abroad when the child was in a stable condition.

Note: MMW was informed by the Minivan News reporter that parents were advised on possible legal action that could be taken.

Chaos and confusion at IGMH!

It was a particularly busy day at IGMH today. The IPD atrium was filled with people of all ages. It appeared as if something was going down at the hospital. Something big.

We had arrived at the hospital at around mid-morning with a friend who was scheduled to consult a doctor at the OPD. Incidentally, a dead body was brought to IGMH by the Maldives Police Services and there was a buzz around the place. Had we not waited a while longer, we would have sworn that everyone was talking about the Bagladeshi national who had apparently taken his own life. We did wait and so did we find out that the story on everyones lips was different. The muffled sounds were for something entirely different.

Yes, IGMH had begun introducing their new patient database and the registration process was causing a few glitches. The crowd at the counters were very well-mannered and patient. They were warned of possible delays and inconveniences. All the counters and service stations were very slow in delivering the services. There was chaos like never before. Everyones patience was tested.

Surprisingly, but thankfully, the vast majority of the people bore the difficulties, accepted the delays and cooperated in the difficult and time consuming process. If the new system was going to make things better in the days to come they were apparently willing to wait patiently for now.

The second ID attempt.

News:

IGMH administration has announced that they will be introducing shortly a patient identification card that would expedite the provision of services to its clients. Any attempt by the hospital administration to improve the speed of service delivery must be acknowledged as a positive change.

We are nonetheless a bit more apprehensive in celebrating the story prematurely. We are reminded of a system of patient identification cards that failed 5 years ago. If implemented this would be the 3rd time IGMH is attempting to introduce patient identification cards.

At the time when IGMH started its services, well before the official inauguration, every patient was given an ID card and files of patient data were stored in the OPD appointment station. The system seemed to be going well during the pilot phase until the number of files increased and maintaining physical files became virtually impossible for the staff. That experience failed and the patient ID cards were phased out and maintaining individual patient records abandoned. Shifa, the first patient database of IGMH was thus abandoned.

Then in 2001-2002 IGMH again attempted to introduce another ID card system to coincide with the launching of their new patient and medical records database; a ready made and exorbitantly costly medical records database software that was superficially customized for IGMH. The ID cards this time were printed -in blue and white- at the time of registering for services at the OPD or IPD counters. The non-laminated pieces of paper carrying the identification information were easily damaged and lost. The system crashed in 2005 when the patient database got overloaded.

At present the system is riddled with multiple hospital medical record numbers allocated for every single patient. Every time a patient visits the OPD clinics he is given a different "hospital number"! Every time the patient reaches the casualty he is also given a different "hospital number". This has led to some of the more frequent visitors to IGMH having up to a hundred, or even more, hospital numbers!

The only area where the records tally a bit better is the inpatient medical records where thankfully patient records carry the same hospital number; allowing for retrieval of old files for reference where needed. This is not easy because of the poor filing system employed, nonetheless it is possible.

We hope that the new ID card system is a well planned system where the problems and difficulties of the past are addressed. For the new ID cards to be successful the medical records database has to be purged of the excessive, and potentially confusing data generated over the past 3 years.

It is our hope that the new ID cards would indeed improve service provision at IGMH. We urge Dr Mohamed Solih and those under his leadership to bring about changes that are more than cosmetic. Unless the actual medical services are improved, the institution fails to deliver.

Information on the past experiences of IGMH provided by an ex-IGMH IT staff who was witness to the events that are described herein.

Report filed by Huzam Ali

Presidents medical cover saved from shame by a boy scout

This is not a joke!!
[scroll down to read the update]

Dr Junaid, an ophthalmologist (a doctor specialized in the treatment of the diseases of the eye), is the current medical doctor accompanying the president of the Maldives on all domestic travel. His experiences and ability in managing any medical condition outside of his professional specialty is arguably limited. Accompanying the president of a country as the chief medical officer with the main responsibility of attending to medical emergencies facing the president and his entourage is not a simple task. We, and indeed any reader who comes to know of this, are shocked that this is the kind of medical cover the head of the state is provided and accepted by him and his advisers.

The Maldivian medical community and the presidents' advisers have been saved from utter humiliation by a brave boy scout. Had the president suffered any significant injury, Dr Junaid would have had no experience what-so-ever in ensuring adequate and safe medical care for him.

We contacted medical doctors who have worked with Dr Junaid at IGMH, including physicians who wished to remain anonymous. We asked them their views on the professional capabilities of Dr Junaid in attending to medical emergencies. All three doctors, senior specialists themselves, had no doubt in their minds that he would have been totally incapable of carrying out the required medical treatments.

We tried to get the opinion of the Maldivian Medical Association on the issue of having an eye specialist working as the sole medical doctor as the medical cover for the president. Their hot-line was unattended and we were unable to get their opinion. We have left multiple messages on their answering machine asking for a response by 8pm tonight, before we make the publication. We even contacted some of the Governing body members over the phone; none would continue the conversation from the point the question is raised! One brave soul said that he was sure that we, MMW, would make a good judgment ourselves.

The Maldivian medical community has many local physicians who would, for obvious reasons, be better trained and experienced to be picked as medical cover for our head of state. Dr Ahmed Razee, Dr Abdul Azeez Yoosuf, Dr Ibrahim Yasir, Dr Abdul Hameed, Dr Ali Latheef, Dr Fathmath Nadhiya, Dr Ibrahim Shiham and Dr Ali Nazeem are internal medicine physicians who are trained and experienced in managing emergencies in the adult population. They are all working at IGMH and are actively involved in managing emergencies and adult medical conditions. It is a shame that the presidents' chief medical adviser Dr Firdous has put the presidents life in harms way by selecting the wrong doctor to be his emergency physician.


Update
[22nd Jan 2008]

Some parts of the media have reported on the issues addressed in the above post but have not presented the facts. We would like to provide additional information and updates to ensure clarity.

Dr Junaid had been accompanying the president for the past 1 year or so. This trip was not the first one. Members of the presidential entourage are very much aware of the limitations in Dr Junaids professional capacity to handle potential emergencies. The president himself, was reportedly aware of the fact that Dr Junaid was an eye specialist.

Dr Junaid was reportedly selected for this post by Dr Mohamed Firdous, the presidents Chief Medical Advisor. All senior level health official were aware of the potential for disaster this appointment had created. Dr Firdous himself is the Chief Medical Cover for presidents' overseas travel.

We can confirm that Dr Junaid has now been removed from Presidential medical protocol. We have also been informed by IGMH and MoH insiders that the issue has been discussed in at least two high level meetings one each at the ministry and IGMH.

Members of the IGMH "special function medical cover team" who usually provide medical cover for government functions such as the July 26th and November 11th official receptions have been asked by IGMH to be available for future trips that the president is expected to undertake. The team includes a Physician, two medical officers and a senior nurse.

What will the new year bring?

The year ending tonight has been one which has brought much suffering to many of us, not just because of illness, but a lot because of the great many inadequacies in our health system. The cost of human loss cannot be quoted in currency, but the cost of poor health, illnesses and neglect of a system would be beyond comprehension.

Minister Ilyas has failed to deliver an improvement to the health system worth anything more than a few name boards labeled "Health Center" or "Atoll Hospital". His team at the Ministry has managed to hold back the health care standard of the country at the same place as was at a decade earlier. The medical people with him, Dr Abdula Azeez Yousuf, Dr Sheena and Dr Ahmed Razee have done little more than draw 3-4 salaries per month!!!

The truly sick in the islands, die at the hands of either incompetent health care providers or a competent provider rendered incompetent by an inadequate health care infrastructure. We are witness to the desperate cries of those who have been left to tend for themselves, we are among them ourselves.

Our premier health institution, IGMH, has won not our hearts, but our anger and hatred for its display of contempt with our needs and wishes. It is little wonder that IGMH has had within its premises mob violence disrupt its services and physical assault cause injuries to staff. The failings of the administration and the inability of it high ranked officials to discharge their responsibilities were at least partly responsible for these events. Deaths, medical negligence, maltreatment and all sorts of medical errors at the institution have made their ways to the news headlines. It speaks volumes about the intentions of the management of the hospital when 2 doctors were suspended for voicing concerns about malpractices happening within the Hospital. Dr Mohamed Solih, Dr Fathmath Ali Didi, Dr Yasir and Ali Mohamed (Alibe') are responsible for the sickening state of affair at IGMH.

Can we expect anything different in the new year? Realistically the chances of that are very little. The system headed by the same individuals from the very top to the middle management level are corrupt, incompetent, selfish and untrustworthy.

One thing will be different though! We will be less tolerant of their criminal handling of our welfare in the coming year. We pledge that we will do all that we can to make sure that we hold them accountable to the people of this country. We have all suffered enough. We deserve better. We demand better.

Corruption within the recruitment process

I paid US$2000 to employment agent in India and then US$1000 to agent in Male' to get a job as a nurse in Male'. [Name withheld, Received by Email]

One senior, lady at Department of Medical Services at the Ministry of Health took money from me as commission for giving me my job in Maldives. [Name withheld, Received by Email]

We have heard of staff shortages in the health sector of the country for many years. There have been rumors that many of those who apply for posts, in response to advertisements in foreign newspapers are prevented from getting a contract unless a bribe is paid to Maldivian and expatriate "agents".

One email that we received did mention a senior level official at DMS, whose name was not mentioned in the email, taking heavy bribes from potential employees before confirming their contracts. Our team made inquiries from contacts within DPH and MoH if there was any truth in these stories. Our contacts were able to confirm that such rumors are rife even within the office. They were however unable to confirm for sure if such activities indeed happen, they said, "the senior level officials would know, but then again- they maybe the people involved too".

One senior doctor, who wished not to be named for obvious reasons, working at a regional hospital talked to a member of the Medical Investigators Team on 27th December 2007 and confirmed that he had to bribe the head of the institute and an official from DMS to renew his contract. He said that every expatriate doctor known to him working in Maldives pays some sort of "fee" or "commission" to officials to ensure their contract was renewed. He swore that to get his first post in Maldives he had paid 2 lac Indian rupees to an agent in India and MRf 10,000 to a Maldivian "agent" upon arrival in Maldives.

We were made to understand that DMS is the government department responsible for recruitment of all medical staff to institutions other than IGMH, which has its own recruitment department Personnel department within IGMH.

The staffing situation at IGMH is also woeful. Several of the key medical departments are chronically short staffed and stretched. There have reportedly been spats between medical staff and the officials at the Personnel department over the pace of the recruitment process including accusations by many of corruption within the recruitment process.

Two doctors from IGMH that we contacted refused to either refute or confirm whether they experienced such procedures when they applied for work at IGMH. Their refusal to discuss the issue and allegations does make one believe that they may have been victims of a similar scam.

The stories that we received may make us believe that high level officials within the Ministry of Health and IGMH are involved in a racket to make money out of the recruitment process. Our contacts within MoH and IGMH share the views.

Expatriate doctors, nurses and paramedical staff have stories to tell. Many of them have allegedly paid bribes and "commisions" in order to get a contract or extension of contract to high level officials.

[We continue to investigate these allegations in order to identify the people involved in the racket]

Non-standard ultrasonography

My wife was 6months pregnant at that time when we went to Kulunu Medical Services for a scan appointment. The sonologist on duty was Dr Fathmath Ali Didi. The scan was done. The only thing she said to us was that "baby was normal" and that "everything was fine". Two and a half months later when baby was delivered, he had gross multiple physical anomalies!
[Received by Email]

Dr Fathmath Ali Didi is the Director of Medical Administration at IGMH, an MBBS graduate who has risen through the ranks initially because of her influential family and now because of the ease with which she can be manipulated by policy makers.

We have been able to confirm that for the past many years she has been a practicing sonologist performing the "job" of PG Radiologists both at the government setup and in private practice. She is however, not a radiologist and has nothing more than the experience of attending a single certificate course on basic ultrasonography years ago. We have been told, and we believe too, that she has over the years acquired skills in operating the ultrasound scan machine and is able to do basic scans.

Nevertheless, lets us not be fooled into believing that she is at all qualified to do complex sonography. The scan referred to in the email had missed fairly gross physical anomalies that should have been seen by the sonographer. We wonder how many such errors had resulted from scans performed by herself and fellow wannabe-radiologist Dr Yaganegi.

We called IGMH to find out what post Dr Fathmath Ali Didi holds within the radiology department. The PRC girl said "she is a consultant". Our contact within the Personnel Department was able to confirm that she held no official post in the radiology department at IGMH. Her posts include Director of Medical Administration and Registrar in Internal Medicine. We have also learned that her qualification is listed as MBBS only. She is not a specialist physician and her post of Registrar in Internal Medicine came as a shock to us. We were made to understand that these types of extra posts were common for high level administrative staff and that it was a way of them earning a higher salary. Incidentally- Dr Yaganegi is also only an MBBS graduate.

One of staff at IGMH reported that Dr Fathmath Ali Didi only does scans when there is a shortage of Radiologists and that she is "usually quite Ok" with obstetric scans. The truth became apparent when we called CEOs office, where her office is. The person who answered said that she was on scan duty at the time and to call later!

This case highlights a serious breach of trust that should exist between service provider and patients. Individuals working in professional capacities well beyond their capabilities and medical qualifications is a serious issue. It could cause serious damage and grievances for patients. From the email, it is evident that it has already happened.

No oxygen in health centers and hospitals

A sick newborn transfered from Gn. Fuvahmulah Atoll Hospital to S. Hithadhoo Regional Hospital bacause of lack of oxygen at the former health facility. [Translation; Minivan Daily]

This report was very concerning. We alerted our team to do a quick investigation and below are our findings.

The story is factual. The baby was transfered to HRH (Hithadhoo Regional Hospital) because baby was having respiratory distress and the oxygen supply at Fuahmulah Atoll Hospital was running out. Our affiliates at HRH confirm that the baby was received at the regional hospital and that the baby is improving.

On a more concerning note though, we can confirm that the lack of oxygen is a problem across all government health facilities including IGMH. Our affiliates within IGMH confirm that apart from a few cylinders, IGMH is running very low on oxygen.

STO and Maldive gas are the suppliers of oxygen to IGMH and DMS (Department of Medical Services). Apparently a financial conflict between the suppliers and the institutions is responsible for the grave situation. Overdue invoices and mismanagement of stock maintenance has put the health of many of our most vulnerable in jeopardy. Jazeera Daily is the only local paper to report on this issue.

As Dr Yasir was unavailable for comment, we tried to call Dr Solih (Executive Director General, IGMH) to inquire about the situation. As custom, his phone was also in silent mode! We were told that Alibe' (Director General, IGMH) was the next in command at IGMH. He and 2 other senior executive, we were told were unavilable at this time, as they were at the Peoples Majlis.

In the atolls, the situatation is different at different centers. At most places there was no oxygen available anyway, because they never had any. However, at most of the health centers report that they have enough oxygen (some reportedly have one extra cylinder on standby! That is 2 cylinders in total).

If the situation does not improve over the next day or so, we will see patients being transfered abroad for oxygen! "Patients in IGMH ICU are high risk of oxygen deprived brain injury in the next 48hrs if things do not improve" said one staff working there. It is a scary thought and a scandalous statement and she may be right too.

The incompetence, corruption, mismanagement and poor planning at IGMH, MoH.....across the board in our health services is putting our lives at risk.